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This study investigates the board's role in shaping insurers' risk-taking using data of 49 Indian insurance firms from 2014 to 2021. We captured the insurer's risk using four proxy measures: underwriting, investment, insolvency and total risks. To address potential endogeneity concerns in the relationship with board attributes, we employ a two-step Generalized Method of Moments (GMM) approach. Robustness checks are conducted using the panel quantile estimation approach. The empirical analysis reveals that life insurers face greater underwriting risk than non-life insurers. A larger board with duality appears to mitigate insurers' risk, particularly in the case of life insurers. The presence of independent directors on insurer boards, along with an optimal frequency of board meetings, effectively mitigates risk among Indian insurers. The study concludes that dual regulations erode regulatory discipline among public insurers, leading to an inadequate governance structure. [ABSTRACT FROM AUTHOR]

The advent of Industry 4.0 presents a spectrum of challenges for entrepreneurs in India, demanding specific skills and resources. Within this transformative landscape, engineering disciplines assume a pivotal role in navigating the complexities of the new industrial revolution yet pose challenges in instilling entrepreneurial skills. While universities are recognised for fostering entrepreneurial skills, a gap persists in comprehending students' intentions to pursue entrepreneurship after completing their studies, especially within technical education systems. This emphasises the necessity for a comprehensive examination of variations in entrepreneurial orientation among diverse engineering disciplines. The study employed cross-sectional research and surveyed 370 final-year engineering students from leading engineering colleges in Karnataka, India. The data analysis included Exploratory Factor Analysis (EFA) and Structural Equation Modeling (SEM). The findings demonstrate a significant propensity for entrepreneurship among engineering students, highlighting attributes such as innovativeness, risk-taking, and proactiveness. However, contrary to expectations, the study does not discern distinct entrepreneurial orientations across different engineering disciplines. Importantly, it unveils that college education has minimal influence on students' entrepreneurial intentions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study is to explore the association of disclosures for the performance of banks in India. Design/methodology/approach: Panel data analysis (utilising static and dynamic models) is applied on the data of 34 Indian banks (for time-frame 2015–2019) to explore the association of disclosures (as transparency and disclosure index) with the performance of banks (as profitability, risk-taking and technical efficiency (TE)). The regulation, competition and ownership concentration variables are taken as control variables. Findings: None of the banks' performance measures applied in the study is significantly associated with the disclosures. This situation implies that disclosures do not impact the performance of the banks in India. The reason is that disclosures and performance are two different activities that aim at different purposes. Research limitations/implications: This study does not provide output for the association between disclosures and the value of the banks and confines itself to explore the association between disclosures and performance of the banks only. This limitation can be the future scope of the study. Originality/value: There is no other study that solely focuses on exploring the association of disclosures with the performance of the banks. Disclosure has more significant importance in banks because of the inherent nature of opaqueness in banking operations. Therefore, the current study's findings have substantial implications for policymakers, managers and investors of the banks. [ABSTRACT FROM AUTHOR]

The locus of control measures how much a person thinks they, rather than outside influences, are in charge of how things turn out in their lives. Financial self-efficacy is influenced by locus of control. Individuals are more likely to believe they can handle their finances when they feel more capable of doing so. In particular, this study focused on married working women in India. They are more likely to effectively manage their finances if they think they can get out of financial difficulties. A questionnaire that was distributed to a convenience sample of 278 yielded responses from married working women across PAN India. The study made use of exploratory factor analysis (EFA), which reveals the scale's factor structure. The study offers statistical evidence to support the scales' reliability and validity. The statistical findings of the investigation show that locus of control and financial literacy has a favourable impact on financial behaviour. The authors also demonstrate how the relationship between internal locus of control and financial behaviour is altered by financial literacy. As a moderator variable that affects the locus of control, financial literacy is an important factor. The research's conclusions are crucial in providing empirical support for the theoretical relationships. This study has confirmed the beneficial effects of internal locus of control and financial literacy on the financial behaviour of married working women, supporting the current literature. Additionally, it has been found that a person's financial conduct and internal locus of control have different relationships depending on their financial literacy. [ABSTRACT FROM AUTHOR]

Purpose: The study's objective is to examine the consumers' intention to buy counterfeit brand shoes. A conceptual model is developed to test the risk-taking and word-of-mouth (WOM) as a moderator in the relationship between status consumption, brand image, and consumer intention to buy counterfeit shoes. Design/methodology/approach: Based on the theory of reasoned action (TRA) and signaling theory (ST), this research was conducted in the Indian National Capital Region. Using a structured instrument, the data was collected from 240 respondents. After checking the psychometric properties of the survey instrument using the Lisrel package of structural equation modeling, Hayes's PROCESS macros were used for testing the hypotheses. Findings: The findings from the study indicate that (1) status consumption and brand image are positively associated with purchase intention of counterfeit brand shoes, and (2) risk-taking moderates the relationship between (1) status consumption and purchase intention, and (2) brand image and purchase intension, (3) significant three-way interaction between WOM, risk-taking and status consumption on purchase intention, and (4) significant three-way interaction between brand image, WOM, and risk-taking on purchase intention of counterfeit brand shoes. Research limitations/implications: As with any survey research, this study has common method variance as a potential problem. However, through the latent variable method and Harman's single-factor analysis, the common method variance was checked. The study has several implications for managers, e-marketers, and consumers. Practical implications: The study has several implications for marketers selling counterfeit products and managers intending to protect their branded products. Originality/value: A conceptual model showing two-way and three-way interactions between status consumption, risk-taking, and WOM influencing the consumer purchase intention of counterfeit products was discussed. This is the first of its kind in India to explore such relationships. [ABSTRACT FROM AUTHOR]

Currently, women are widely recognized as successful entrepreneurs because of their strong desire, qualities, and abilities in order to drive robust economic development in their respective countries. In light of women's significant contribution to economic development in India, the study investigated factors that affect women entrepreneurs' success. As part of the data collection process, 181 SME Chambers of India were contacted, and structured questionnaires were distributed to them. It consists of the development of a conceptual model and the use of SPSS and AMOS software for the analysis of the data. A number of factors contribute to the success of women-owned enterprises on the international market, including internal factors such as achievement, risk-taking, and technology adaptation and external factors such as economics and socio-culture. The study recommends that the Small and Medium Enterprises Chamber of India, policymakers, and practitioners support women entrepreneurs by providing an array of incentives and supports related to those internal and external factors. We investigated some internal factors like technology adaptation that are still almost untouched in India after the post-pandemic pandemic. Numerous studies have examined different factors' effects on women's entrepreneurial success. In addition to adding empirical evidence to the existing literature, the current study contributes to the existing literature. [ABSTRACT FROM AUTHOR]

Twins are subject to a similar environment and their togetherness experience can lead to increased confidence manifested as increased risk taking or the constant comparison and expectation of similar performance can also lead to anxiety and obsessive compulsive traits. This study aims to find the level of risk taking and prevalence of obsessive compulsive traits among twins as well as the relationship between their experience as twins to the risktaking and obsessive behaviour. A sample of 100 adolescents, 50 being one of a twin pair and 50 singleton adolescents, from Kodinhi village, known for its high twin population, were studied using the Toronto Obsessive-Compulsive Scale, Risk Taking-18 and data on twin behaviour. Datawas analyzed employing the Kolmogorov Smirnov test, Kruskal-Wallis test, Mann-Whitney test and Spearman's Correlation. The findings suggest that twins are significantly higher in obsessive compulsive traits than singletons and that they are significantly lower on risk taking. There was a significant negative relationship between obsessive-compulsive traits and risk-taking. We also found out a significant relationship between people's comparison of twins and the level of obsessive-compulsive traits in them. [ABSTRACT FROM AUTHOR]

Previous studies have suggested a trait-like association between neighborhood deprivation and alcohol consumption. However, it is not known whether temporarily manipulating poverty and affluence states by exposure to stimuli signifying resource-scarcity or resource-wealth would influence alcohol-seeking behavior. Here, we aimed to investigate whether implicit exposure to affluence and poverty-related pictures would influence beer consumption. Participants in a "poverty" group viewed pictures depicting impoverished environments, and participants in an "affluence" group viewed images of wealthy environments. After priming, participants were provided with nonalcoholic beer (which they were told was alcohol-containing beer) and orange juice under the guise of a bogus taste test, to measure their alcohol-seeking behavior. Results showed that priming participants with a resource-scarce environment led to an increase in beer consumption (as a percentage of total fluid consumed), compared to priming with a resource-rich environment. The same pattern of results was obtained in both a Western European sample (Experiment 1) and a West Indian sample (Experiment 2). In Experiment 2, we also tested whether risk-taking behavior, measured by the Balloon Analogue Risk Task, was influenced by the environmental priming; no differences between groups were observed. These results provide the first experimental evidence that manipulation of poverty-affluence state, by brief exposure to pictures of impoverished or wealthy neighborhoods, can influence alcohol-seeking behavior in adult social drinkers. [ABSTRACT FROM AUTHOR]

Purpose This study aims to investigate the impact of the presence of women directors on firm’s risk-taking behavior in industries where innovation is pivotal and how this impact varies across ownership structure.Design/methodology/approach A sample of 71 listed technology firms on the National Stock Exchange of India for the period of 2008 to 2013 was used. Generalized method of moment estimation technique was used for data analysis.Findings Results reveal a positive impact of the presence of women directors on technology firms’ risk-taking behavior measured in terms of R&D spending, which is in contrast to the traditional notion that women are risk-averse. Further, results also reveal that family ownership negatively affects the impact of the presence of women directors on risk taking in technology firms.Practical implications The findings of the study suggest that females are risk takers in the context of R&D-intensive technology firms, thus providing new insight for policymakers to formulate more effective board gender diversity policies.Originality/value Based on the integration of agency and behavioral theories, it is suggested that female executives may be risk-averse or risk-takers depending on contextual factors such as innovation and ownership, which drive the impact of the presence of women directors on firms’ risk-taking behavior. [ABSTRACT FROM AUTHOR]

Aim: To estimate the prevalence and associated factors with the human immune-deficiency virus (HIV) among people who inject drugs (PWID) in Mizoram, Northeast India., Methods: The data source for the analysis was the 2019-2020 Mizoram State AIDS Control Society (MSACS) survey from 2695 PWID registered for the Targeted Intervention (TI) services. Logistic regression analysis was conducted to examine the factors associated with HIV among PWID after adjusting for sociodemographic characteristics, injection, and sexual behaviours., Results: 21.19% of the participants tested positive for HIV and the prevalence of HIV among male and female participants were 19.5% and 38.6%, respectively. Multiple logistic regression analysis revealed that female (AOR 1.74; 95% CI 1.26-2.41), 35 years or older (AOR 1.45; 95% CI 1.06-1.99), married (AOR 1.41; 95% CI1.08-1.83), divorced/separated/widowed (AOR 2.12; 95% CI 1.59-2.82) and sharing of needle/syringe (AOR 1.62; 95% CI 1.30-2.00) were all positively associated with HIV infection. We also found that concomitant alcohol use was reduced by 35% (AOR 0.65; 95% CI 0.51-0.82) among HIV positive PWID, and HIV infection was also reduced by 46% (AOR 0.54; 95% CI 0.44-0.67) among those PWID who use a condom with a regular partner., Conclusion: The findings of this study suggested that there is a high prevalence of HIV among PWID with 1 in 5 PWID reported to have HIV. HIV among PWID was significantly higher among those over 35 years of age, females and divorced/separated/widowed participants. Needle/syringe sharing behaviour is an important determinant of HIV infection. The high prevalence of HIV among PWID population is multifactorial. To reduce HIV among PWID in Mizoram, interventions should target those sharing needles/syringes, females, especially those over 35 years of age and unmarried participants., Competing Interests: The authors have declared no competing interest exist, (Copyright: © 2023 Pachuau et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study aimed to examine the changes in and predictors of the human immunodeficiency virus (HIV) among people who inject drugs (PWID) in Mizoram, Northeast India, over a period of 15 years (2007-2021). A sample of 14783 PWID was extracted from the Targeted Intervention (TI) services under the Mizoram State AIDS Control Society (MSACS). A chi-square test was used to compare the differences in HIV prevalence across the three 5-year periods, and a multiple logistic regression analysis was used to determine predictors after adjusting for sociodemographic, injecting and sexual behaviours. The results showed that compared to 2007-2011, HIV prevalence was almost three times higher in 2012-2016 (AOR 2.35; 95% CI 2.07-2.66) and almost two times higher in 2017-2021 (AOR 1.41; 95% CI 1.24-1.59). The results suggest that participants who were females (AOR 2.35; 95% CI 2.07-2.66), married (AOR 1.13; 95% CI 1.00-1.27), separated/divorced/widowed (AOR 1.74; 95% CI 1.54-1.96), of middle school level education (AOR 1.24; 95% CI 1.06-1.44), sharing needles/syringes (AOR 1.78; 95% CI 1.61-1.98) and receiving a regular monthly income were positively associated with HIV infection. Condom use with a regular partner (AOR 0.77; 95% CI 0.70-0.85) was high among PWID. Despite targeted interventions under MSACS to reduce HIV in Mizoram, the prevalence of HIV/AIDS among PWID remained high between 2007 and 2021. Policymakers and stakeholders should tailor future interventions based on the factors identified in this study that are associated with HIV infection. Our findings highlight the importance of socio-cultural factors in HIV epidemiology among PWID in Mizoram.

Background: It is important to understand the current internet-related sexual behaviours of high-risk groups such as men who have sex with men (MSM). We designed the present study to understand the types of online/mobile apps used by MSM and male-to-female transgendered people/hijras [TGH] in Mumbai, India. We also compared the internet-related 'partner seeking' and 'sexual behaviours' in MSM and TGH in Mumbai, India., Methods: This is a cross-sectional analysis of secondary data collected (April to June 2020) from 8582 MSM and 4163 TGH from five targeted intervention programmes each in Mumbai, Maharashtra, India. Data on demographics, years of association with the intervention, number and type of online/mobile apps used, sexual behaviours including partners from virtual space and non-virtual (physical) space, group sex, attending parties, mobility for sexual partners, and HIV status were collected., Results: MSM were more likely to have mobile phone (88% vs 51%, p < 0.001) and internet access over the phone (78% vs 27%; p < 0.001) compared with TGH. The common apps used by MSM were Grindr (48%), Facebook (42%), and Blued (36%). MSM were more likely to have partners from virtual space (91% vs 67%; p < 0.001). A higher proportion of MSM had attended parties (28% vs 2%; p < 0.001), had group sex (16% vs 6%; p < 0.001), and were mobile for sex (25% vs 4%). MSM and TGH who had partners from virtual space were significantly more likely to report 'missed a condom at least once during penetrative sex in the past one week' (17% vs 12%; p<0.001). In HIV positive MSM, group sex, parties, and mobility for sex, were only in those who reported partners from the virtual space., Conclusions: Internet-based interventions for MSM should be incorporated in the existing targeted intervention programme and outreach workers should be trained in virtual outreach services. Among TGH, given the low reach and use of smartphones and apps, internet-based interventions may not be such a useful option, and the existing physical targeted intervention programmes should be strengthened., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Acharya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: High HIV prevalence among injecting drug users (IDUs) remains a cause of concern and are considered key drivers of concentrated epidemic in India. The present paper aims to assess the effectiveness of the targeted intervention (TI) program on the risk behaviors among IDUs across regions of India., Materials and Methods: This paper used the data from the integrated biological and behavioral surveillance 2014-2015 among the IDUs in India. Descriptive statistics and propensity score matching analysis was carried out to understand the effectiveness of the TI program on the new needle/syringe used and needle/syringe shared in the last injecting episode by accounting for the covariates., Results: The matched samples estimate, i.e., average treatment effect on treated of new needles/syringe used and shared in the last injecting episode by those who received needles/syringes from peer educator or outreach workers (PE/ORWs) and those who did not receive was 2.8% (confidence interval [CI]: 0.05-5.6) increase in the use of new needles/syringes and 6.5% (CI: -9.7--3.3) decrease in the needles/syringes shared in last injecting episode indicating that IDUs who received new needles/syringes from PE/ORWs are more likely to use new needle/syringe and less likely to share needle/syringes to those who did not receive needles/syringes. The results vary across the different regions of India., Conclusion: TI program proves to be an effective initiative in the behavior change among IDUs as substantiated by use of new needles/syringes and decreased sharing of needles/syringes. TI program coverage varies from region to region and may further be expanded to accelerate the program services to prevent HIV/AIDS., Competing Interests: None

Context: Concerns about road safety have been increasingly associated with two-wheeler riding and especially with young commuters in India. Aims: The study was designed to explore inclination to speeding and to profile the driving behaviors in two-wheeler riding young men and women who reported a tendency to ride faster than their peers. Design: A cross-sectional survey design was used. Materials and Methods: On the basis of three focus group discussions and review of literature, a survey was prepared to tap domains such as affect states associated with riding/speeding, factors contributing to speeding, inclination for competing, perceived speed and safety, etc. The study sample comprised of 961 two-wheeler riding college-going young men and women in Bangalore. Statistical Analysis: Descriptive and inferential statistical procedures were used including Chi-square, Spearman's rank correlation, and independent sample t-test. Results: The sample was divided into two subgroups on the basis of self-report of greater speeding than one's peers. A subgroup of 349 participants endorsed the item regarding inclination to ride faster than one's peers, whereas, the remaining 612 participants did not endorse it. The profiles of these two subgroups were obtained in terms of sociodemographic variables, riding behaviors, and associated domains. Significant differences between the subgroups emerged on domains such as motives for riding fast, tendency for competing, perceived safety and frequency of minor accidents while riding. Conclusions: Several correlates of the tendency to speeding among young two-wheeler riders emerged that have implications for enhancing safe riding. [ABSTRACT FROM AUTHOR]

Background: Little is known about the epidemiology of HIV infection among HIV positive people who inject drugs (PWID) in India. Injecting drug use has emerged as an important route of HIV transmission in India. The objective of this study was to conduct a systematic review on the risk behaviours associated with HIV infection among HIV positive PWID and assess the data reported., Methods: A systematic search of six electronic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase and Ovid Medline was conducted. These databases were searched for published studies on injecting risk behaviours, sexual risk behaviours and socio-demographic factors associated with HIV infection among HIV positive PWID in India., Results: A total of 15 studies were included in the review of which 3 studies evaluated HIV/HCV coinfection among HIV positive PWID. Older age, low educational level and employment status were significantly associated with HIV infection. Sharing of syringe and needle, frequency of injection, early initiation of injecting practice, inconsistent condom use and having multiple sexual partners were all commonly associated with HIV infection among HIV positive PWID., Conclusion: Our study identified significant injecting and sexual risk behaviours among HIV positive PWID in India. There is an increasing HIV transmission among PWID in different states, more so in the northeastern states and in metropolitan cities in India. More studies need to be conducted in other regions of the country to understand the true burden of the disease. The lack of sufficient data among HIV positive female PWID does not preclude the possibility of a hidden epidemic among female PWID. The need of the hour is for the prevention of further transmission by this high-risk group through the provision of comprehensive programs, surveillance and robust continuation of harm reduction services., (© 2022. The Author(s).)

Objectives: This study provides insights on the impact of a targeted intervention (TI) programme on behaviour change among injecting drug users (IDUs) in India., Methods: This paper examined the data from the Integrated Biological and Behavioural Surveillance 2014-2015 for IDUs in India. Logistic regression was performed to understand the factors (TI programme services) that affected injecting risk behaviours by adjusting for covariates. Propensity score matching was conducted to understand the impact of the TI programme on using new needles/syringes and sharing needles/syringes in the most recent injecting episode by accounting for the covariates that predicted receiving the intervention., Results: Participants who received new needles and syringes from peer educators or outreach workers were 1.3 times (adjusted odds ratio, 1.29; 95% confidence interval [CI], 1.09 to 1.53) more likely to use new needles/syringes during most recent injecting episode than participants who did not receive needles/syringes. The matched-samples estimate (i.e., average treatment effect on treated) of using new needles in the most recent injecting episode showed a 2.8% (95% CI, 0.0 to 5.6) increase in the use of new needles and a 6.5% (95% CI, -9.7 to -3.3) decrease in needle sharing in the most recent injecting episode in participants who received new needles/syringes. There was a 2.2% (95% CI, -3.8 to -0.6) decrease in needle sharing in the most recent injecting episode among participants who were referred to other services (integrated counselling and testing centre, detox centres, etc.)., Conclusions: The TI programme proved to be effective for behaviour change among IDUs, as substantiated by the use of new needles/syringes and sharing of needles/syringes.

The occurrence of occupational accidents and injuries has always been a major concern for industrial management. Such undesirable incidences are higher in developing countries, especially in India, than in developed countries. This research aims to identify, analyze and evaluate the faulty behavior risks (FBRs) that trigger occupational accidents and injuries. Using a data triangulation strategy, this study identified 19 FBR factors under five categories. An integrated approach comprising the fuzzy analytic network process (ANP) and the decision-making trial and evaluation laboratory (DEMATEL) method is proposed for assessing these FBRs. The five most prominent critical risk factors are the absence of continuous monitoring, defective equipment and maintenance, cognitive bias, proper signage and adverse ambient working conditions. The study postulates some implications for industrial management to mitigate occupational accidents and injuries based on the outcomes.

Background & objectives: Despite the central role of cognition for mental disorders most studies have been conducted in western countries. Similar research from other parts of the world, particularly India, is very limited. As a first step in closing this gap this cross-cultural comparability study of the South Texas Assessment of Neurocognition (STAN) battery was conducted between USA and India. Methods: One hundred healthy adults from Kerala, India, were administered six language independent subtests of the Java Neuropsychological Test (JANET) version of the STAN, assessing aspects of general intellectual ability (Matrix Reasoning), attention (Identical Pairs Continuous Performance, 3 Symbol Version Test; IPCPTS), working memory (Spatial Capacity Delayed Response Test; SCAP), response inhibition (Stop Signal Reaction Time; SSRT), Emotional Recognition and Risk taking (Balloon Analogue Risk Task; BART). Test results were compared to a demographically matched US sample. Results: Overall test performance in the Kerala sample was comparable to that of the US sample and commensurate to that generally described in studies from western countries. Interpretation & conclusions: Our results support the metric equivalence of currently available cognitive test batteries developed in western countries for use in India. However, the sample was restricted to individuals who were literate and had completed basic primary and secondary education. [ABSTRACT FROM AUTHOR]

The authors characterized human immunodeficiency virus (HIV) and hepatitis C virus (HCV) incidence and prospective changes in self-reported risk behavior over 2 years among 1,158 injection drug users (IDUs) recruited in Chennai, India, in 2005–2006. At baseline, HIV prevalence was 25.3%, and HCV prevalence was 54.5%. Seropositive persons with prevalent HIV infection were used to estimate baseline HIV incidence by means of the Calypte HIV-1 BED Incidence EIA (Calypte Biomedical Corporation, Portland, Oregon). Longitudinal HIV and HCV incidence were measured among 865 HIV-negative IDUs and 519 HCV antibody-negative IDUs followed semiannually for 2 years. Participants received pre- and posttest risk reduction counseling at each visit. Estimated HIV incidence at baseline was 2.95 per 100 person-years (95% confidence interval (CI): 1.21, 4.69) by BED assay; observed HIV incidence over 1,262 person-years was 0.48 per 100 person-years (95% CI: 0.17, 1.03). HCV incidence over 645 person-years was 1.71 per 100 person-years (95% CI: 0.85, 3.03). Self-reported risk behaviors declined significantly over time, from 100% of participants reporting drug injection at baseline to 11% at 24 months. In this cohort with high HIV and HCV prevalence at enrollment, the authors observed low incidence and declining self-reported risk behavior over time. While no formal intervention was administered, these findings highlight the potential impact of voluntary counseling and testing in a high-risk cohort. [ABSTRACT FROM PUBLISHER]

The article examines the determinants of banks' charter value and its disciplining effect on bank risk-taking since the mid-1990s. The analysis indicates that deposit and loan market concentration exert a significant effect on charter value, suggestive of a strong link between competition and charter value. Among the traditional banking activities, bank size and efficiency are found to be important determinants of charter value. The disciplining effect of charter value is robust across several measures on bank risk. [ABSTRACT FROM AUTHOR]

Objective: To identify the latent classes of modifiable risk factors among the patients with diabetes and hypertension based on the observed indicator variables: smoking, alcohol, aerated drinks, overweight or obesity, diabetes and hypertension. We hypothesised that the study population diagnosed with diabetes or hypertension is homogeneous with respect to the modifiable risk factors., Design: A cross-sectional study using a stratified random sampling method and a nationally representative large-scale survey., Setting and Participants: Data come from the fourth round of the Indian National Family Health Survey, 2015-2016. Respondents aged 15-49 years who were diagnosed with either diabetes or hypertension or both were included. The total sample is 22 249, out of which 3284 were men and 18 965 were women., Primary and Secondary Outcome Measures: The observed variables used as latent indicators are the following: smoking, alcohol, aerated drinks, overweight or obesity, diabetes and hypertension. The concomitant variables include age, gender, education, marital status and household wealth index. Latent class model was used to simultaneously identify the latent class and to determine the association between the concomitant variables and the latent classes., Results: Three latent classes were identified and labelled as class 1: 'diabetic with low-risk lifestyle' (21%), class 2: 'high-risk lifestyle' (8%) and class 3: 'hypertensive with low-risk lifestyle' (71%). Class 1 is characterised by those with a high probability of having diabetes and low probability of smoking and drinking alcohol. Class 2 is characterised by a high probability of smoking and drinking alcohol and class 3 by a high probability of having high blood pressure and low probability of smoking and drinking alcohol., Conclusions: Co-occurrence of smoking and alcohol consumption was prevalent in men, while excess body weight and high blood pressure were prevalent in women. Policy and programmes in Northeastern India should focus on targeting multiple modifiable risk behaviours that co-occur within an individual., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Areca nut use, along with tobacco, is a contributor to India's high rates of oral cancer. Areca nut use is culturally accepted, often initiated early in adolescence, and said to lead to later tobacco use. Unlike tobacco prevention, there are scarce prevention or harm-reduction programmes or campaigns specifically targeted at areca nut., Methods: A participative ranking method was used to understand adolescents' assessment of risks of areca nut. Five focus group discussions were conducted with 31 adolescents, 19 fe-male and 12 male, non-users and users of chewing tobacco, water-pipe (hookah) and areca nut. Participants categorized and ranked the risk of 16 activities, including the use of areca nut and various tobacco-products, and discussed reasons for these risk-rankings., Results: Despite differences between groups on the assessment of risks associated with the 16 different activities, all the groups, user and non-user, rated cigarette smoking as having the highest risk, chewing fennel and using mouth fresheners as no risk, and areca nut as low risk. The other activities were ranked differently by each group. Adolescents' perceptions of smoking or online games as risky was influenced by greater exposure to messaging on harmful consequences of the activity through multiple channels such as mass media, interpersonal networks including parents, and classroom health-education sessions. Inadequate knowledge about the harmful consequences of areca nut use, greater social and cultural acceptability, and the sweet taste of commercially packaged areca nut influenced low-risk perceptions., Conclusion: Perceptions of risk from an activity often determines preventive behaviors. Presently, adolescents do not perceive areca use as risky. In comparison to smoking they con-sider it less harmful. More research is required to better understand areca nut use and its cul-tural determinants. However, targeted health communication messages and prevention poli-cies and programmes have to be initiated to reduce areca nut use and associated burden of oral cancer.

This study aimed to examine the effect of a syndemic theory-based intervention to reduce condomless anal intercourse among men who have sex with men (MSM) in India. In 2016/17, a pre- and post-test comparison group design was used to implement a syndemic theory-based intervention among 459 MSM (229, intervention; 230, standard-of-care comparison) recruited through non-governmental organizations in Chandigarh, India. The intervention group received two-session peer-delivered motivational interviewing-based HIV risk reduction counselling and skills training to improve sexual communication/negotiation and condom use self-efficacy, and screening/management of psychosocial health problems. The intervention's effect on consistent condom use was estimated using difference-in-differences (DiD) approach. Mediation analysis assessed the extent to which intervention effects on the outcome were mediated by changes in psychosocial health problems and condom use self-efficacy. A process evaluation assessed implementation fidelity and intervention acceptability. Baseline consistent condom use was 43% in the intervention group and 46% in the standard-of-care group. Baseline survey findings demonstrated that a psychosocial syndemic of problematic alcohol use, internalised homonegativity and violence victimisation synergistically increased condomless anal intercourse. Using DiD, we estimated that the intervention increased consistent condom use with male partners by 16.4% (95% CI: 7.1, 25.7) and with female partners by 28.2% (95% CI: 11.9, 44.4), and decreased problematic alcohol use by 24.3% (95%CI: -33.4, -15.3), depression by 20.0% (95% CI: -27.6, -12.3) and internalised homonegativity by 34.7% (95% CI: -43.6%, -25.8%). The mediation analysis findings suggested that the intervention might have improved consistent condom use by decreasing internalised homonegativity and by increasing condom use self-efficacy. The process evaluation showed high levels of acceptability/satisfaction among participants and high levels of implementation fidelity. A syndemic theory-based intervention tailored for MSM in India is feasible, acceptable, and can reduce HIV transmission risk behaviour as well as problematic alcohol use, depression and internalised homonegativity., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: In India, the HIV epidemic is concentrated among Key Populations (KPs), such as men who have sex with men (MSM), who bear a disproportionate burden of HIV disease. Conventional targeted interventions (TI) mitigate HIV transmission among MSM by focusing on physical hotspots. As increasingly, there is a shift within India's MSM community to connect with sex partners online, novel approaches are needed to map virtual platforms where sexual networks are formed. The objective of this study was to estimate the number of MSM in Delhi using virtual platforms to connect for sex and to describe patterns of their use., Methods: The study was conducted in the state of Delhi among MSM over 18 years of age who used virtual platforms to look for sexual partners. Virtual platforms were identified through community consultations. Size estimation was carried out by enumerating the number of online users, accounting for duplication across sites and time and based on interviews with 565 MSM., Results: 28,058 MSM (95% CI: range 26,455-29,817) use virtual sites to find sexual partners. We listed 14 MSM specific virtual sites, 14 general virtual sites, 19 social networking pages and 112 messenger groups, all used by MSM. Five virtual sites met feasibility criteria to be included in the virtual mapping. Of the MSM on these sites, 81% used them at night and 94% used them on Sundays, making these the peak time and day of use. Only 16% of users were aware of organizations providing HIV services and 7% were contacted by peer educators in the preceding three months. Two-fifths (42%) also visited a physical location to connect with sexual partners in the month prior to the study., Discussion: TI programs that focus on physical hotspots do not reach the majority of MSM who use virtual sites. MSM active on virtual sites have a low awareness of HIV services. Virtual mapping and programmatic interventions to include them must be incorporated into current public health interventions to reach MSM at risk of HIV., Competing Interests: The authors have declared that no competing interests exist.

Background: Motorcycles are one of the most commonly used transportation modes in low and middle-income countries. In India, motorized two-wheelers comprise 70% of the total vehicle population, and motorcycle users are considered the most vulnerable road users. It is essential to understand the risky riding behaviour and associated factors among the motorcyclists to develop evidence-based traffic safety programs targeting motorcycle riders. The purpose of the current study was two-fold. First, it aimed to determine the appropriate structure of a modified version of the MRBQ among young riders in Manipal, India. Second, it assessed to what extent MRBQ factors were associated with self-reported crash involvement and violations., Methods: The motorcycle rider behaviour questionnaire (MRBQ) is a 43-item scale that assesses five aspects of risky motorcycle rider behaviour, i.e., violations, control errors, traffic errors, stunts, and protective equipment. The MRBQ, along with measures of socio-demographic variables and the number of motorcycle crashes, was filled out by 300 young motorcycle riders who were in the age group of 18-25 years and had been riding for at least the past three years (93% males, 92.3% students)., Results: Five factors emerged out of the MRBQ after an exploratory factor analysis: traffic errors, control errors, stunts, protective equipment, and violations. Cronbach's alpha for these factors ranged from .66 to .82. Reports of performing stunts and committing violations were positively associated with self-reported near-crash experiences over the past three months. Riders reporting stunts, violations and using a motorcycle of 125-200 cc reported having received more fines in the last three months. These findings were confirmed in both univariate and multivariate binary logistic regression models., Conclusion: The study assessed the factor structure of a modified version MRBQ and the extracted factors associations with self-reported crash involvement. The factor structure revealed in the current study is consistent with MRBQ factor structures found in other countries. However, the support for a relationship between MRBQ factors and self-reported crashes was less significant. The findings suggest that if replicated by future studies, local policymakers are advised to focus on the five MRBQ factors while planning future interventions to achieve a reduction in the number of road crashes among motorcyclists., (© 2021. The Author(s).)

Background: Substance use among adolescents is risky behavior that had emerged as a concern in both developed and developing countries. Evidence revealed that substance use is more frequent among those adolescents whose immediate family members (parents, siblings and grandparents) also indulge in such consumption; however, scarce literature is present in the Indian context. Therefore, the present study examined whether substance use among family members and in the community is associated with the substance use behavior of adolescent boys in Uttar Pradesh and Bihar., Method: We used the data for 5969 adolescent boys aged 10-19 years from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey conducted in 2016. A three-level random intercept logit model was utilized to understand the association of adolescent substance use behavior with familial and community context., Results: We found that 16% of adolescent boys were using any substance (tobacco or alcohol or drug). The substance use was significantly higher among adolescent boys who were school dropouts (40%) than those who were currently in school. The prevalence of substance use is also high among those who were working (35%). Moreover, 19, 24 and 28% of the adolescents come from families where at least one of the family members consumed tobacco, alcohol and drugs, respectively. The odds of substance use were 2.13 times [CI:1.44-3.17] higher among those adolescent boys whose family members also indulged in substance use. Moreover, the likelihood of substance use was 1.24 times [CI:1.01-1.68] higher among the adolescent boys who come from a community with high substance use. Additionally, the risk of substance use is more likely among adolescent boys belonging to the same household of the same community., Conclusion: It is evident that exposure to substance use in the family and community increases the likelihood of substance use among adolescent boys. There is a need for household- and community-level programmatic interventions to alleviate the risk of substance use among adolescents., (© 2021. The Author(s).)

Background: Although drug use stigma is globally pervasive, quantitative evidence of its role in hepatitis C virus (HCV) transmission is limited. We evaluated the psychometric properties of a drug use stigma scale and examined the association between drug use stigma and active HCV infection among a community-based sample of people who inject drugs (PWID) in India., Methods: Between 8/2016 and 5/2017, a cross-sectional sample of PWID was recruited from 12 Indian cities (~1000/city) using respondent-driven sampling. Participants were ≥18 years old and reported injection drug use (IDU) in the past 2 years. Multivariable logistic regression with a random-intercept for each city was used to estimate adjusted odds ratios (aOR) of active HCV infection (RNA>30 IU/mL). Analyses incorporated RDS-II weights., Results: Of 11,663 participants, 73.1% reported IDU in the past 6 months and 33.8% had active HCV infection. Exploratory factor analysis yielded a four-factor solution of enacted, vicarious, felt normative and internalized drug use stigma with high internal consistency (Cronbach's α: 0.85-0.92). In analyses adjusted for age, gender, northeast region, education, homelessness, incarceration, alcohol dependence, HIV status, frequency of IDU, and ever sharing needles/syringes, PWID reporting any enacted stigma had greater odds of active HCV infection (aOR = 1.27 [95% CI = 1.13-1.43]) as did PWID with internalized stigma scores in the highest quartile (vs. lowest quartile; aOR = 1.69 [95% CI = 1.11-2.56]). Among PWID who reported IDU in the past 6 months, multiple forms of stigma were associated with higher frequency of IDU, sharing needles/syringes, having multiple injection partners, and IDU in public spaces., Conclusion: Using a multidimensional drug use stigma scale, various forms of stigma were significantly associated with active HCV infection and injection drug use-related risk behaviors. Collectively, these data suggest that drug use stigma may play a role in HCV transmission and impede efforts to achieve HCV elimination. Strategies to diminish drug use stigma are warranted., Competing Interests: Declarations of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Powered two-wheelers (PTW) constitute the most vulnerable type of road user, primarily due to their lack of protection compared to other motorized vehicles, which can lead to a severe accident in the event of crashes. A notable increase in the percentage of PTW accidents resulting in fatalities has raised a serious need for further research in understanding riding behavior. The Motorcycle rider behavior questionnaire (MRBQ) based studies have shown promising results by using MRBQ to relate riding behavior with crash risk. Despite numerous studies using the MRBQ technique and inconsistency in derived inferences across the studies highlighted the need to revise MRBQ and carry out predictive validity for capturing the correct riding behavior of Indian riders. Therefore, this research modified the previously available questionnaire by considering the focus group's opinion, consisting of twenty professional riders, two transportation experts, and two traffic police officers. Additionally, the predictive validity check of MRBQ was carried out using a sample of Indian riders consisting of 392 participants. The exploratory factor analysis of the MRBQ revealed a 32 item version of the questionnaire divided into a four-factor structure (traffic errors, control errors, speed violations, and stunts). The present research highlighted some critical dissimilarities between PTW riders of India and other countries. The low mean score (based on the Likert scale) of the items under the four-factor structure indicated overall a safe PTW rider behavior of Indian riders. Among the four factors, speed violation showed the highest mean score and stunts showed the least mean score indicating frequent and infrequent aberrant ridding behaviors, respectively. A known group construct validity check revealed that gender had a significant and age an insignificant effect on the reporting of aberrant riding behaviors. Furthermore, a negative binomial regression analysis revealed that traffic error had the highest incidence rate ratio, confirming it to be the most significant predictor of crash risk for Indian riders. Finally, the study briefly discussed counter-measure strategies targeting specific riding behavior., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

HIV prevalence is higher among Men who have Sex with Men (MSM), owing to their unsafe sexual behavior. Further, MSM indulge in behaviors such as consumption of alcohol/oral drugs and/or injecting during/before sex that poses the risk of unsafe behaviors, thereby increasing their vulnerability to HIV. The study aims to analyze the factors associated with HIV infection among the multi-risk MSM using any substances with those MSM who do not use substances.Community-based cross-sectional survey design using probability-based sampling between October 2014 and November 2015.For the nation-wide Integrated Biological and Behavioral Surveillance (IBBS), 23,081 MSM were recruited from 4067 hotspots in 108 districts across India. Information on demographics, sexual behaviors, substance use, sexual partners, and awareness on HIV and its management was collected from the consented respondents using computer-assisted personal interview (CAPI) by trained personnel. Blood samples were tested for HIV. Statistical analyses were done, to study the associations between substance use and its influence on high-risk sexual behaviors and HIV infection.One in 3 MSM (33.88%) in India were substance users, thus exhibiting "multi-risk" (MR) behaviors. Significantly higher HIV prevalence (3.8%, P < .05) was reported among MR-MSM, despite 97.2% of them being aware of HIV. Higher HIV prevalence among MSM exhibiting homosexual behavior for ≤1 year is of specific concern, as this accounts to recent infections and indicates the increased vulnerability of the infection among the new entrants.Substance-use resulting in high-risk sexual behavior was significantly associated with higher HIV prevalence among MR-MSM. Integrated targeted interventions focusing on safe sex and safe-IDU practices among MR-MSM are required to end the disease transmission.

Background: The sexual behaviour of adolescents is of importance due to the engagement in risky sexual activity at a too early age, which may be associated with the adverse outcomes. The study aims to understand the transitions in adolescent boys and young men's high-risk sexual behaviour in India using two rounds of Indian demographic health survey, NFHS-3 (2005-06) and NFHS-4 (2015-16)., Methods: A total of 25,538 in NFHS-3 (2005-06) and 35,112 in NFHS-4 (2015-16) men were considered for the analysis. Men have been divided into two age groups as 15-19 years (adolescent) and 20-24 (young men) for comparison purposes. Descriptive and multivariate statistics have been used., Results: Overall, high-risk sexual behaviour has increased among adolescent boys (64 to 70%) and young men (18 to 27%) from 2005-06 to 2015-16. The trend of live-in relationship has increased among adolescent boys of rural areas (0.6 to 6.0%) as well as in urban areas (3.1 to 10.9%) over the last 10 years. Adolescent boys having 10th and above years of schooling (AOR = 1.98; p < 0.01), residing in urban areas (AOR = 2.23; p < 0.01), and belonging to the affluent class of households (AOR = 1.41; p < 0.05) were more likely to engage in high-risk sexual activity than the young men in India. The odds of high-risk sexual behaviour was higher among alcohol-using adolescent boys (AOR = 1.82; p < 0.01) and young men (AOR = 2.38; p < 0.01) in 2015-16., Conclusions: The study concludes that early sexual debut, lower prevalence of condom use at first sexual experience, tendency of live-in-relationship, and alcohol consumption indicate the hazardous interconnection between such behaviours among adolescent boys over the last decade which placed them at higher-risky sexual behaviour as compared to young men. Adolescent' sexual behaviours have both short-term and long-term consequences, and interventions that focus on multiple domains of risk may be the most effective in helping to promote broad reproductive health among young adults.

Background: Data from high-income countries suggest increasing hepatitis C virus (HCV) prevalence/incidence among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM), but limited data derive from low-and-middle-income countries., Methods: We recruited 4994 MSM from 5 states across India using respondent-driven sampling. Logistic regression incorporating respondent-driven sampling weights and machine learning feature selection were used to identify correlates of prevalent HCV, and Bayesian phylogenetic analysis was used to examine genetic clustering., Results: The median age was 25 years, the HIV prevalence was 7.2%, and 49.3% of participants reported recent unprotected anal intercourse. The HCV prevalence was 1.3% (95% confidence interval, 1.0%-1.6%; site range, 0.2%-3.4%) and was 3.1% in HIV-positive versus 1.1% among HIV-negative men. HCV infection was significantly associated with injection drug use (odds ratio, 177.1; 95% confidence interval, 72.7-431.5) and HIV infection (4.34; 1.88-10.05). Machine learning did not uncover any additional epidemiologic signal. Phylogenetic analysis revealed 3 clusters suggestive of linked transmission; each contained ≥1 individual reporting injection drug use., Conclusions: We observed a low HCV prevalence in this large sample of MSM despite a high prevalence of known risk factors, reflecting either the need for a threshold of HCV for sexual transmission and/or variability in sexual practices across settings., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Electronic Patient Reported Outcomes (PROs), which consist of questionnaires administered directly to patients via handheld device or computer, allow for the routine and systematic capture of sensitive domains as well as longitudinal data on functional status, symptom severity, and physical and psychological well-being. There have been few examples of PROs in HIV care in low- and middle-income countries (LMICs) and none in India. We conducted a study to assess the feasibility and acceptability of PROs at the Y.R. Gaitonde Centre for AIDS Research and Education in Chennai, Tamil Nadu. We adapted an adherence and psychosocial questionnaire into an electronic PRO format and administered it to a convenience sample of 50 participants. Almost all participants indicated that the PRO questionnaire was easy to complete and understand (96%). The percentage who needed any staff help was 83% among illiterate participants but only 13% among literate participants ( p <0.001). In summary, an electronic PRO questionnaire was feasible and acceptable in an HIV care center in southern India. Further study, with special attention towards optimizing PROs for persons with low literacy and limited technology experience, is needed to maximize the potential of PROs within HIV care in India.

Risk and time preferences have often been viewed as reflecting inherent traits such as impatience and self-control. Here, we offer an alternative perspective, arguing that they are flexible and environmentally informed. In Study 1, we investigated risk and time preferences among children in the United States, India, and Argentina, as well as forager-horticulturalist Shuar children in Amazonian Ecuador. We find striking cross-cultural differences in behavior: children in India, the United States, and Argentina are more risk-seeking and future-oriented, whereas Shuar children are more risk-averse and exhibit more heterogeneous time preferences, on average preferring more today choices. To explore 1 of the socioecological forces that may be shaping these preferences, in Study 2, we compared the behavior of more and less market-integrated Shuar children, finding that those in market-integrated regions are more future-oriented and risk-seeking. These findings indicate that cross-cultural differences in risk and time preferences can be traced into childhood and may be influenced by the local environment. More broadly, our results contribute to a growing understanding of plasticity and variation in the development of behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Prevalence of adult HIV infection in India is still high in certain North-eastern (NE) states, particularly among injecting drug users (IDUs). This study aims at exploring IDU behavior profile and their variation across the different states of NE region, India. Data were drawn from a population-based, cross-sectional survey of IDU in the integrated bio-behavioral surveillance from 2014 to 2015. A total of 4272 IDUs from four states (Manipur, Meghalaya, Mizoram, and Nagaland) aged ≥15 years were interviewed. Descriptive analysis was conducted to identify the variation in demographic and IDU behavior across four states. Youth predominance in Mizoram was evident by the mean age of initiation <18 years; 74% and 65% had the first exposure of any drug and injecting drug in <20 years. In Manipur and Nagaland, 60% and 49% of IDUs, respectively, were ≥30 years of age. These specific age groups may be targeted for IDU risk mitigation addressing the state-specific determinants., Competing Interests: None

Background: Hijra or transgender (H/TG) people are significantly affected by HIV in India. HIV prevalence among H/TG is the second highest after people who inject drugs. Effective interventions require understanding about various risk behaviors and associated factors for high prevalence., Objectives: This study analyzes the known risk behaviors and vulnerabilities of HIV-positive and HIV-negative H/TG people to identify the determinants of HIV seropositivity in this high-risk group., Methods: Using secondary data from India's 2014 to 2015 Integrated Biological and Behavioural Surveillance survey, this analysis was conducted among 3325 H/TG people across seven states. Probability-based sampling methods were used to recruit H/TG people. Informed consent was obtained for the collection of behavioral information and blood samples for HIV testing. Multivariable binary logistic regression analysis was undertaken to identify the determinants of HIV seropositivity., Results: HIV prevalence for this group of respondents was 9.5%. Multivariable analysis of survey data revealed higher odds of HIV infection if H/TG had regular male partners (adjusted odds ratio [AOR]: 1.81, confidence interval [CI]: 1.07-3.06), were living in the states of Maharashtra (AOR: 6.08, CI: 3.02-12.22) and Odisha (AOR: 2.91, CI: 1.05-8.06), and were members of self-help groups (AOR: 2.08, CI: 1.04-4.14). None of the demographic or behavioral correlates of risk were found to be associated with HIV infection., Conclusion: The findings suggest that community and structural factors, which are inadequately covered in surveys such as IBBS, play a more important role than individual behavioral factors., Competing Interests: None

Background: During round 2017 of HIV Sentinel Surveillance (HSS) for men who have sex with men (MSM) in India, sampling strategy was changed from consecutive sampling to random sampling, and recruitment was conditioned on informed written consent., Objective: The study aimed to explore whether inclusion of informed consent is associated with HIV seropositivity rates among MSM population in select four states of Central India., Methods: The cross-sectional study was conducted in four states of Delhi, Jharkhand, Uttar Pradesh, and Uttarakhand that were supervised by All India Institute of Medical Sciences, New Delhi. We did analysis of data collected during 2017 HSS, supplemented with additional program data from targeted intervention (TI) sites. All nine MSM sites in four states were included. Participants were defined as all those MSM who participated in HSS 2017 irrespective of whether they were mentioned in the random list or were selected by the TI partner. The MSM in the random list who either refused to participate or could not be contacted even after three attempts were classified as "nonparticipants." Seropositivity of both groups was compared. Descriptive statistics were derived., Results: Overall nonparticipation rate was 14.7%, the highest being in Jharkhand (26%) and lowest in Uttarakhand (6.8%). Overall HIV positivity rate was significantly higher (P < 0.001) in nonparticipants (4.2%) when compared to participants (1.42%)., Conclusion: The change in sampling strategy and introduction of written informed consent for recruitment of high-risk groups in HSS 2017 round could have led to an underestimation of HIV seropositivity rate among MSM in the states in Central Zone., Competing Interests: None

Background: Female sex workers (FSWs) have been identified as an important target group for human immunodeficiency virus (HIV)/sexually transmitted infections prevention., Objectives: This study aimed to describe sociodemographic and sex work characteristics and to identify the risk factors for HIV infection with special focus on the variations between home-based (HB) and non-HB (NHB) FSWs in three high-prevalent North-Eastern states of India: Manipur, Mizoram, and Nagaland., Methods: Data from the National Integrated Bio-Behavioural Surveillance (IBBS) conducted in India during 2014-2015 were utilized in the study. IBBS is a quantitative survey conducted among identified high risk sub within India. Logistic regression analyses were performed using SAS 9.3.2 to determine the distribution and associations of sociodemographics and risk behaviors with HIV seropositivity of HB and NHB FSWs., Results: HIV prevalence was found higher among NHB FSWs compared to HB FSW (7.3% vs. 4.6%). The proportions of FSW among HB (66.7%) were in sex work for longer duration are significantly higher than for NHB (60.2%) while risk of HIV infection due to injecting drug use was higher in NHB FSW (11.7% vs. 8.7%). Reference to FSW who were currently married, those who were widowed/divorced/separated had 2.73-fold risk of HIV. FSW who did not have any other income source were associated with 1.73 times more risk of HIV infection. Injecting drugs user among FSW respondents had four times higher likelihood to be HIV positive., Conclusion: A substantial proportion of NHB FSWs is mobile in nature. Targeted interventions are required urgently to minimize HIV risk among those FSWs especially the widowed/divorced/separated, sex work is only income source and who used injecting drugs for nonmedical purpose., Competing Interests: None

Background: Targeted interventions (TIs) are one of the most effective strategies to control HIV/AIDS transmission, especially among the high-risk groups (HRGs). Implementation of HIV/AIDS control strategies relies heavily on estimation of the size of HRG population. Size estimation for key populations such as female sex workers (FSWs), men who have sex with men (MSM), and injecting drug users (IDUs) is a crucial component of national HIV strategic planning., Objective: The objective of this study was to estimate the size of FSWs, MSM, and IDUs in various states of India., Methods: The program multiplier method was used to estimate the size of FSWs, MSM, and IDUs across the country using two distinct but overlapping data sources - Integrated Bio-Behavioral Surveillance and TI program from the same geographical area at the same time period., Results: In India, as on 2018-2019, there were nearly 18.2 lakhs estimated FSWs accounting to 0.53% among female population aged 15-49 years, with a highest in West Bengal (4.5 lakhs); 5.7 lakhs estimated MSM accounting to 0.16% among male population aged 15-49 years, with a highest in Gujarat (0.7 lakh); and 3.9 lakhs estimated IDUs accounting to 0.11% among male population aged 15-49 years, with a highest in Uttar Pradesh (0.5 lakh)., Conclusions: The current size estimates on HRGs will support the development of projections and estimations of the HIV epidemic at national and state levels. These estimates also help in framing national guidelines such as HIV strategic planning, program design, allocation of resources, prioritizing the interventions, and monitoring and evaluation., Competing Interests: None

Background: The proximity of Northeast India to the Golden Triangle facilitates easy accessibility to illicit drugs, resulting in a higher proportion of injecting drug users (IDUs) in the states of Northeast India. The estimated human immunodeficiency virus (HIV) prevalence among IDU in Manipur which is 1.43% is higher than that of the national figure., Objectives: The objectives of the study were to find the factors associated with HIV infection and correlate the association between HIV status and self-assessed risk to HIV among IDUs in Manipur., Methods: National Integrated Biological and Behavioral Surveillance (2014-2015) data were used for the study; all analyses done were weighted. In Manipur, information was collected from 1594 IDUs during the surveillance between 2014 and 2015 across four domains, namely Chandel (396), Imphal East (397), Thoubal (401), and Senapati (400). Chi-square test was performed to test the association between the independent and dependent variables. Multivariable logistic regression was performed to identify risk factors associated with HIV positivity., Results: Higher age, unsafe injecting practice, low education status, and low-income status were significantly (P < 0.05) associated with HIV infection among IDUs in Manipur. Self-assessed risk of HIV infection by IDU was significantly associated with HIV positivity., Conclusion: Interventions among IDUs in Manipur should focus on emphasizing safe injecting practices along with creating awareness on HIV prevention and management., Competing Interests: None

Public health and media discourses on men and HIV prevention in India have largely focused on changing knowledge, attitudes and risk behaviour pertaining to condom use and safe sex. Little attempt has been made towards intervening in areas such as masculinity, dominant gender norms and intimate partner violence (IPV) that have been shown to have a direct link to HIV prevalence. In this paper, drawing on findings from an ethnographic study in northern Karnataka (India), we show how socio-political and communicative contexts influence and perpetuate violent behaviours by men in intimate relationships with female sex workers (FSW). We argue that constructions of masculinity, the stereotypes of which are reinforced through contemporary media, and movies, are intricately linked with processes of nationalism and play out in forms of chauvinism among working-class men. Violence, celebrated through various patriarchal discourses, legitimises and reinforces gender ideals that govern the private lives of men and their female intimate partners. This study provides a complex and nuanced understanding of structural factors that lead to IPV against FSWs and offers implications for HIV intervention planning in the region and beyond.

Background: The rollout of antiviral therapy in Low and Middle Income Countries (LMICs) has reduced HIV transmission rates at the potential risk of resistant HIV transmission. We sought to predict the risk of wild type and antiviral resistance transmissions in these settings., Methods: A predictive model utilizing viral load, ART adherence, genital ulcer disease, condom use, and sexual event histories was developed to predict risks of HIV transmission to wives of 233 HIV+ men in 4 antiretroviral treatment centers in Maharashtra, India., Results: ARV Therapy predicted a 5.71-fold reduction in transmissions compared to a model of using condoms alone, with 79.9%, of remaining transmissions resulting in primary ART-resistance., Conclusions: ART programs reduce transmission of HIV to susceptible partners at a substantial increased risk for transmission of resistant virus. Enhanced vigilance in monitoring adherence, use of barrier protections, and viral load may reduce risks of resistant HIV transmissions in LMIC settings.

Injury has been increasing exponentially, especially in children, and it has become a public health concern. The present study was conducted with the objective of determining the prevalence and profile of unintentional injury among children of 1-5-year age group in a rural community of India and also to find out the predictors. Primary caregiver was interviewed by using a structured interview schedule. Parent supervisory behaviour was assessed using Parent Supervision Attributes Profile Questionnaire (PSAPQ), and child injury risk-taking behaviour was assessed by using injury behaviour checklist (IBC). Children encountered any unintentional injury event during last three-month period were 261 (62.7%). PSAPQ score was significantly higher in those parents where children had no episode of injury compared to others. Among four components of the PSAPQ, protectiveness ( p  = 0.049) and risk tolerance ( p  = 0.001) score had significant positive association with the incidence of unintentional injury. Binary multivariable logistic regression technique had found that age of the child, gender, primary care giver, birth order of the baby, the number of siblings, social class and IBC score has significant association with history of unintentional injury. There is utmost need for the development of effective programmes and training strategies to prevent unintentional injury among under-five children in future.

Social learning strategies are key for making adaptive decisions, but their ontogeny remains poorly understood. We investigate how social information use depends on its source (adults vs. peer), and how it is shaped by household composition (extended vs. nuclear), a factor known to modulate social development. Using a simple estimation task, we show that social information strongly impacts the behaviour of adolescents aged 11 to 15 years (N = 256), especially when its source is an adult. However, social information use does not depend on household composition: the relative impact of adults and peers was similar in adolescents from both household types. Furthermore, adolescents were found to directly copy others' estimates surprisingly frequently. This study provides novel insights into adolescents' social information use and contributes to understanding the ontogeny of social learning strategies., Competing Interests: The authors have declared that no competing interests exist.

Background: Self-report measures of sensation seeking though commonly used in research have not undergone factor structure or psychometric validation in Indian adolescents. The Brief Sensation Seeking Scale - Chinese (BSSS-C; Chen et al., 2013) is a less culture specific tool with excellent psychometric properties and presents a suitable option for use with Indian adolescents., Aim: The present study aims to validate the factor structure, evaluate the psychometric properties, and examine the gender invariance of the BSSS-C in Indian adolescents., Methods: A community sample of adolescent, n = 2079, with mean age 17 years (SD = 1.71) completed the BSSS-C, the BIS/BAS, and the Adolescent Risky Behaviour scales., Results: The four factor structure of the BSSS-C exhibited good to excellent model fit, acceptable internal consistency reliability (α = 0.77) and, adequate construct as well as concurrent validity in Indian adolescents. Invariance testing revealed that the factor configuration and factor loadings of the BSSS-C were equivalent across the gender. Three of the four BSSS-C latent factors were amenable for mean comparisons across the gender., Conclusion: BSSS-C is a reliable measure of the four dimensional model of sensation seeking in Indian adolescents. The gender differences in the BSSS-C factors are attributable to real differences in sensation seeking construct between male and female adolescents., (Copyright © 2019 Elsevier B.V. All rights reserved.)

: Most health research on Nepali migrant workers in India is on sexual health, whilst work, lifestyle and health care access issues are under-researched. Background: The qualitative study was carried out in two cities of Maharashtra State in 2017. Twelve focus group discussions (FGDs) and five in-depth interviews were conducted with Nepali male and female migrant workers. Similarly, eight interviews were conducted with stakeholders, mostly representatives of organisations working for Nepali migrants in India using social capital as a theoretical foundation. Methods: Five main themes emerged from the analysis: (i) accommodation; (ii) lifestyle, networking and risk-taking behaviours; (iii) work environment; (iv) support from local organisations; and (v) health service utilisation. Lack of basic amenities in accommodation, work-related hazards such as lack of safety measures at work or safety training, reluctance of employers to organise treatment for work-related accidents, occupational health issues such as long working hours, high workload, no/limited free time, discrimination by co-workers were identified as key problems. Nepali migrants have limited access to health care facilities due to their inability to prove their identity. Health system of India also discriminates as some treatment is restricted to Indian nationals. The strength of this study is the depth it offers, its limitations includes a lack of generalizability, the latter is a generic issue in such qualitative research. Results: This study suggests risks to Nepali migrant workers' health in India range from accommodation to workplace and from their own precarious lifestyle habit to limited access to health care facilities. We must conduct a quantitative study on a larger population to establish the prevalence of the above mentioned issues and risks. Furthermore, the effectiveness of Nepali migrant support organisations in mitigating these risks needs to be researched.Conclusion: This study suggests risks to Nepali migrant workers' health in India range from accommodation to workplace and from their own precarious lifestyle habit to limited access to health care facilities. We must conduct a quantitative study on a larger population to establish the prevalence of the above mentioned issues and risks. Furthermore, the effectiveness of Nepali migrant support organisations in mitigating these risks needs to be researched.

Introduction: There are limited data on young people who inject drugs (PWID) from low- and middle-income countries where injection drug use remains a key driver of new HIV infections. India has a diverse injection drug use epidemic and estimates suggest that at least half of PWID are ≤30 years of age. We compared injection and sexual risk behaviours and HIV incidence between younger and older PWID and characterized uptake of HIV testing and harm reduction services to inform targeted HIV prevention efforts., Methods: We analysed cross-sectional data from 14,381 PWID recruited from cities in the Northeast and North/Central regions of India in 2013 using respondent driven sampling (RDS). We compared "emerging-adult" (18 to 24 years, 26% of sample) and "young-adult" PWID (25 to 30 years, 30% of sample) to older PWID (>30 years, 44% of sample) using logistic regression to evaluate factors associated with three recent risk behaviours: needle-sharing, multiple sexual partners and unprotected sex. We estimated age-stratified cross-sectional HIV incidence using a validated multi-assay algorithm., Results: Compared to older adults, emerging-adults in the Northeastern states were significantly more likely to share needles (males adjusted odds ratio [aOR] 1.82; females aOR 2.29, p < 0.01), have multiple sexual partners (males aOR 1.56; females aOR 3.75, p < 0.01), and engage in unprotected sex (males aOR 2.29, p < 0.01). In the North/Central states, young-adult males were significantly more likely to needle-share (aOR 1.23, p < 0.05) while emerging-adult males were significantly more likely to have multiple sexual partners (aOR 1.74, p < 0.05). In both regions, emerging-adults had the lowest HIV testing. Participation in harm reduction services was low across all age groups. Annual HIV incidence was higher in emerging- and young-adult PWID in the North/Central region: emerging-adults: 4.3% (95% confidence interval [CI] 3.0, 5.6); young-adults: 4.9% (95% CI 3.7, 6.2); older adults: 2.1% (95% CI 1.4, 2.8)., Conclusions: Higher HIV incidence and engagement in risky behaviours among younger PWID compared to older PWID, coupled with low utilization of harm reduction services highlight the importance of targeting this population in HIV programming. Age-specific interventions focused on addressing the needs of young PWID are urgently needed to curb the HIV epidemic in this vulnerable population., (© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)

Background: Unsafe injecting drug use is a documented risk factor for the transmission of human immunodeficiency virus infection. Harm reduction strategy aims at reducing this deleterious consequence., Objectives: To study the prevalence and predictors of injecting as well as sexual risk behavior among male injecting drug users (IDUs)., Methods: A cross-sectional study was conducted among 250 male IDUs from January 2017 to March 2018. Risk behavioral data were collected after obtaining informed consent of the study participants. This included information on sharing, reusing needles/injections, and sexual behavior. Descriptive statistics and logistic regression model was run using the Epi Info software version 7.2 for Windows., Results: In the past one month, 25.3% had shared needles/syringes by either borrowing or lending or both. Inconsistent condom use during sexual intercourse with a regular, casual, and paid sex partner was practiced by 64.7% (77/119), 65.8% (48/73), and 45.0% (18/40), respectively. The binary logistic regression analysis revealed that unsafe injecting drug behavior was higher among daily users: (OR = 3.0 [1.3-6.6]) and comparatively lower among those who preferred to avail needles/syringes from Needle Syringe Exchange Program (OR = 0.4 [0.2-0.9]); as compared to their counterparts., Conclusions: The findings suggest that IDUs in the study area are engaging in risk behaviors. Behavior change communication and harm reduction strategy should be strengthened., Competing Interests: None

Unprotected sex, common among people who inject drugs, puts them and their partners at risk of sexually transmitted infections including human immunodeficiency virus (HIV). This analysis assesses the changes in sexual risk behavior with regular female partners (RFPs), among married men who inject drugs, before and after implementation of a HIV prevention intervention, and identifies correlates of unprotected sex. People who inject drugs (PWID) were assessed at three points: baseline, preintervention follow-up visit (FV)1, and postintervention FV2. Descriptive analysis was used for reporting changes in sexual behavior over time. Generalized estimating equation assessed the population-averaged change in self-reported unprotected sex with an RFP, attributable to intervention uptake. Multivariable logistic regression determined correlates of self-reported unprotected sex with an RFP at FV2. Findings suggest that the proportion of men reporting any unprotected sex remained high (baseline = 46.0%, FV1 = 43.5%, FV2 = 37.0%). A reduction was observed in unprotected sex after the intervention phase, but this could not be attributed to uptake of the intervention. Higher odds of self-reported unprotected sex with an RFP in the past three months at FV2 were associated with self-reported unprotected sex at baseline, living with family, and being HIV-negative. Married male PWID should receive counseling for safe sex with RFPs, especially those who are HIV-negative and live with their families.

Objectives: The present study is an attempt to analyze and compare the distraction effects caused by the use of a phone and a music player at unsignalized intersections. Method: Eighty-eight participants performed simulated driving experiments where they faced a sequence of gaps in the major road traffic at 2 unsignalized intersections. In this process, their driving behavior was evaluated in terms of gap acceptance probability, accepted lag, and maneuver completion time. These parameters were modeled with a generalized estimating equation (GEE) method by considering distraction, demographic factors, driving history, maneuver types, and driving attributes in the approach and completion zones as independent variables. Results: The results showed that gap acceptance probability decreased by 46% during the conversation task, whereas it increased by 66% during the music player task. Lower gap acceptance could be a compensatory behavior adopted by drivers during the conversation task, whereas no such measure was adapted during the music player task. The results indicate that a higher approach speed during the music player task might have led to increased gap acceptance. Further, though the effect of distraction on the accepted lag was not evident, the completion time was reduced during the conversation task. Conclusions: Overall, the results suggest that drivers are more likely to adopt a compensatory measure in complex driving situations only if they perceive a high risk. Hence, drivers are exposed to a greater risk while operating a music player, because this is not perceived as risky behavior.